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Safe use of livers from donors with positive hepatitis B core antibody
Author(s) -
Manzarbeitia Cosme,
Reich David J.,
Ortiz Jorge A.,
Rothstein Kenneth D.,
Araya Victor R.,
Munoz Santiago J.
Publication year - 2002
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2002.33451
Subject(s) - medicine , liver transplantation , antibody , virology , hepatitis b , core (optical fiber) , immunology , transplantation , materials science , composite material
Abstract Thirty‐five patients received liver transplants using liver donors who had positive test results for the hepatitis B core antibody (HBcAb). In the same time frame, 195 patients received HBcAb‐negative liver donors. Mean follow up for patients receiving HBcAb‐positive donors was 25 months. All patients receiving HBcAb‐positive donors were monitored for recurrence of hepatitis B (HBV) with HBV DNA assays. There was no de novo HBV in recipients of HBcAb‐negative grafts. In the group of patients receiving HBcAb‐positive donors, 4 of 35 patients died within 3 months after transplant with no evidence of HBV recurrence at time of death. Four patients were transplanted for HBV‐related disease and were postoperatively placed on lamivudine and hepatitis B immune globulin (HBIG). HBV recurrence was seen in one of these patients. Of the remaining 27 patients, three of three mismatched patients (HBcAb‐positive donor to HBcAb‐negative recipient) developed de novo HBV (100%). Of 24 matched patients (HBcAb‐positive donor to HBcAb‐positive recipient), only two (7%) developed recurrent HBV allograft reinfection. All de novo and recurrent HBV infections were successfully managed with HBIG and lamivudine therapy. Survival for this subgroup of patients receiving HBcAb‐positive donors for non‐HBV–related liver disease was 100%. We conclude that the judicious use of HBcAb‐positive donors is reasonably safe and associated with low morbidity and mortality, with the appropriate follow‐up protocols. Additionally, lamivudine use can be reserved for those cases with de novo or recurrent HBV in the liver allograft, or, selectively, as prophylaxis in those recipients patients who are naïve to HBV and receive an HBcAb‐positive donor.